CATARRH OF THE MOUTH. 433 



and dryness of the mouth are either unobserved, or are seen only tem- 

 porarily. 



Quite early in the affection there is decided swelling of the mucous 

 membrane and submucous tissue, increased secretion, and excessive 

 formation of young cells. The swelling is most evident at the edges 

 of the tongue and over the cheeks. The tongue appears too broad to 

 lie between the teeth, and its sides show impressions of the teeth. A 

 turbid mucus covers the cheeks, gums, and especially the tongue. The 

 mucus and young cells most readily adhere to the filiform papillae, thus 

 giving a coated tongue. 



Chronic oral catarrh has similar symptoms. The swelling of the 

 mucous membrane is usually even more decided ; on the inner surface 

 of the lips and cheeks, and on the roof of the mouth, we not unfre- 

 quently find small nodules as large as a barley-corn (swelled mucous 

 glands) ; thick yellow mucus covers the gums, especially about the 

 teeth ; the elongated processes of the filiform papillae appear as small 

 white threads, and give the tongue a felty or hairy look (lingua hir- 

 suta). On microscopical examination (Miguel), it is found that the 

 coating of the tongue, even in chronic oral catarrh, consists mostly of 

 epithelial cells. These contain fat globules and brown granules, and 

 not unfrequently unite together into brown plaques. At the same 

 time we see rod-like formations, the broken epithelial processes of the 

 filiform papillae (IZoUiker). Felt-like formations grow on these, their 

 matrix forming a granular border to the hardened epithelial cells. 

 "We also find fat-globules, vibrioncs, and usually some remains of 

 food. 



SYMPTOMS AND COTTKSE. Besides what we have said in the pre- 

 ceding paragraph, there is little to add to the objective symptoms. In 

 the severe forms of acute oral catarrh, which we first described, there 

 is a feeling of burning and tension in the mouth. Babies no longer 

 bite the ivory ring or orris-root, which is usually given them to facili- 

 tate the cutting of the teeth. They cry when we touch their mouths., 

 and, on attempting to nurse, they soon let go of the nipple, as if it hurt 

 them. In some cases, whose frequency is magnified by the laity, so-called 

 " teething convulsions " occur, which may prove fatal without leaving 

 any material changes in the central organs to be seen on post-mortem 

 examination. From our present knowledge of the subject, these con- 

 vulsions must be considered as reflex symptoms, which are caused by 

 the severe irritation of the sensitive nerves of the mouth being trans- 

 ferred through the central organs to the motor nerves. Indeed, it is 

 doubtful whether these attacks are caused by the acute oral catarrh, 

 or are the result of direct irritation of the sensitive nerves from the 

 pressure of the teeth. (See chapter on Eclampsia.) 

 29 



